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Esophagogastric Junction Morphology on Hill's Classification Predicts Gastroesophageal Reflux with Good Accuracy and Consistency.
Digestive Diseases and Sciences ( IF 3.1 ) Pub Date : 2020-02-20 , DOI: 10.1007/s10620-020-06146-0
Ali Osman 1 , Manal M Albashir 1 , Kalyana Nandipati 2 , Ryan W Walters 3 , Subhash Chandra 4
Affiliation  

INTRODUCTION Hill's classification provides a reproducible endoscopic grading system for esophagogastric junction morphology and competence, specifically whether the gastroesophageal flap valve (GEFV) is normal (grade I/II) or abnormal (grades III/IV). However, it is not routinely used in clinical practice. We report a systematic review and meta-analysis to determine association between abnormal GEFV and gastroesophageal reflux disorder (GERD). METHODS A comprehensive literature search of MEDLINE and Scopus databases was conducted to identify studies that reported the association between abnormal GEFV and GERD. The search and quality assessment were performed independently by two authors. Fixed- and random-effects meta-analyses were conducted using symptomatic GERD and erosive esophagitis as outcomes. RESULTS A total of 11 studies met inclusion criteria that included a total of 5054 patients. In the general population, patients with abnormal GEFV had greater risk of symptomatic GERD compared to patients with a normal GEFV (risk ratio [RR] 1.88, 95% CI 1.57-2.24). Further, in patients with symptomatic GERD, patients with abnormal GEFV had greater risk of erosive esophagitis compared to patients with normal GEFV (RR 2.17, 95% CI 1.40-3.36). Finally, the specificity of abnormal GEFV for symptomatic GERD was 73.3% (95% CI 69.3-77.0%) and 75.7% (95% CI 65.9-83.4%) for erosive esophagitis in symptomatic GERD. CONCLUSION Our systematic review and meta-analysis showed consistent association between abnormal GEFV indicated by Hill's classification III/IV and symptomatic GERD and erosive esophagitis. Our recommendation is to include Hill's classification in routine endoscopy reports and workup for GERD.

中文翻译:

Hill分类中的食管胃交界处形态可预测胃食管反流的准确性和一致性。

引言Hill的分类为食管胃交界处的形态和能力,特别是胃食管瓣阀(GEFV)正常(I / II级)或异常(III / IV级)提供了可再现的内窥镜分级系统。但是,它不是临床实践中常规使用的。我们报告了系统的审查和荟萃分析,以确定异常的GEFV和胃食管反流疾病(GERD)之间的关联。方法对MEDLINE和Scopus数据库进行全面文献检索,以鉴定报告异常GEFV与GERD之间相关性的研究。搜索和质量评估由两位作者独立进行。使用有症状的GERD和糜烂性食管炎作为结果,进行了固定效果和随机效果的荟萃分析。结果共有11项研究符合纳入标准,其中包括5054例患者。在一般人群中,GEFV异常的患者与有症状的GEFV的患者相比,出现症状性GERD的风险更大(风险比[RR] 1.88,95%CI 1.57-2.24)。此外,在有症状的GERD患者中,GEFV异常的患者比正常GEFV的患者患糜烂性食管炎的风险更高(RR 2.17,95%CI 1.40-3.36)。最后,异常GEFV对有症状的GERD的侵蚀性食管炎的特异性为73.3%(95%CI 69.3-77.0%)和75.7%(95%CI 65.9-83.4%)。结论我们的系统评价和荟萃分析显示,希尔氏III / IV级与有症状的GERD和糜烂性食管炎相关的异常GEFV之间存在一致性。我们的建议是将希尔
更新日期:2020-02-20
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